Two-dimensional cardiac mapping

ABSTRACT

A method consisting of formulating a one-to-one correspondence between locations on a three-dimensional surface of a body cavity and coordinates in a two-dimensional coordinate frame representative of the locations. The method also includes recording respective time-varying electrical potentials at the locations. The method further includes displaying a map of the two-dimensional coordinate frame, and presenting respective graphic representations of the time-varying electrical potentials at positions in the map corresponding to the coordinates of the locations.

FIELD OF THE INVENTION

The present invention relates generally to cardiac electrophysiology,and specifically to visualizing the cardiac electrophysiologicalbehavior.

BACKGROUND OF THE INVENTION

Displaying electrophysiology (EP) data of a beating heart in anintelligible and clear manner is a daunting task. Even ignoring themotion due to the beating, the EP data changes over time in bothmagnitude and position, and the changes are relatively quick. Inaddition, the EP data occurs in three dimensions.

PCT application WO/2008/135731, to Francis et al., whose disclosure isincorporated herein by reference, describes a method of generating amodel of a cardiac surface. The method comprises measuring anelectrogram voltage at a plurality of points within a heart, andgenerating images representing each electrogram voltage.

Documents incorporated by reference in the present patent applicationare to be considered an integral part of the application except that tothe extent any terms are defined in these incorporated documents in amanner that conflicts with the definitions made explicitly or implicitlyin the present specification, only the definitions in the presentspecification should be considered.

The description above is presented as a general overview of related artin this field and should not be construed as an admission that any ofthe information it contains constitutes prior art against the presentpatent application.

SUMMARY OF THE INVENTION

An embodiment of the present invention provides a method, including:

formulating a one-to-one correspondence between locations on athree-dimensional surface of a body cavity and coordinates in atwo-dimensional coordinate frame representative of the locations;

recording respective time-varying electrical potentials at thelocations;

displaying a map of the two-dimensional coordinate frame; and

presenting respective graphic representations of the time-varyingelectrical potentials at positions in the map corresponding to thecoordinates of the locations.

Typically, the method includes inserting a distal tip of a probe havingan electrode into the body cavity, and recording the time-varyingpotentials includes using the electrode to record the potentials. Themethod may also include determining the locations on thethree-dimensional surface using the electrode.

In a disclosed embodiment the map includes markings corresponding tofeatures of the three-dimensional surface.

In an alternative disclosed embodiment the map includes annotationsdescriptive of elements of the three-dimensional surface.

In a further disclosed embodiment the graphic representations includerectangular bars having lengths selected in response the electricalpotentials. Alternatively or additionally, the graphic representationsinclude bars having colors selected in response the electricalpotentials.

The method may include presenting information concerning the bodycavity, other than the graphic representations, on the map.

In an alternative embodiment displaying the map includes selecting asection of the body cavity, and presenting the graphic representationsonly for the section. Typically, the selecting includes choosing from agroup including manual selection, semi-automatic selection, andautomatic selection.

In a further alternative embodiment presenting the respective graphicrepresentations of the time-varying electrical potentials includesselecting a window of the potentials, and presenting the representationsin response to the window. Typically, the method includes selecting asection of the body cavity, and presenting the graphic representationsof the window only for the section.

In a yet further alternative embodiment the method includes delineatinga path followed by the time-varying electrical potentials in the bodycavity, and displaying the path on the map. Typically, the methodfurther includes presenting the graphic representations of thepotentials only for the path.

There is further provided, according to an embodiment of the presentinvention, apparatus, including:

a controller, configured to:

formulate a one-to-one correspondence between locations on athree-dimensional surface of a body cavity and coordinates in atwo-dimensional coordinate frame representative of the locations, and

record respective time-varying electrical potentials at the locations;and

a screen, coupled to the controller, and configured to:

display a map of the two-dimensional coordinate frame, and

present respective graphic representations of the time-varyingelectrical potentials at positions in the map corresponding to thecoordinates of the locations.

There is further provided, according to an embodiment of the presentinvention, a computer software product including a non-transitorycomputer-readable medium having computer program instructions recordedtherein, which instructions, when read by a computer, cause the computerto:

formulate a one-to-one correspondence between locations on athree-dimensional surface of a body cavity and coordinates in atwo-dimensional coordinate frame representative of the locations;

record respective time-varying electrical potentials at the locations;

display a map of the two-dimensional coordinate frame; and

present respective graphic representations of the time-varyingelectrical potentials at positions in the map corresponding to thecoordinates of the locations.

The present disclosure will be more fully understood from the followingdetailed description of the embodiments thereof, taken together with thedrawings, in which:

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic, pictorial illustration of a cardiacelectrophysiology (EP) system, according to an embodiment of the presentinvention;

FIG. 2 is a schematic diagram illustrating two different views ofelements of a heart, according to an embodiment of the presentinvention;

FIG. 3 is a schematic diagram of a two-dimensional (2D) map, accordingto an embodiment of the present invention;

FIG. 4 is a schematic diagram of voltage vs. time graphs, according toan embodiment of the present invention;

FIG. 5 is a schematic diagram illustrating graphic displays of thereplay of gated records, according to an embodiment of the presentinvention; and

FIG. 6 is a schematic diagram illustrating an alternative graphicdisplay of the replay of the gated records, according to an embodimentof the present invention.

DETAILED DESCRIPTION OF EMBODIMENTS Overview

An embodiment of the present invention provides a method for viewingtime-varying electrophysiological potentials of the three-dimensional(3D) surface of a body cavity, such as one or more chambers of theheart. The method allows simultaneous viewing of the potentials,regardless of the location on the surface at which the potentials aremeasured, while maintaining a visual correlation between the potentialsand the locations.

A one-to-one correspondence between the 3D locations and coordinates ina two-dimensional coordinate frame representative of the locations isformulated and a map of the two-dimensional coordinate frame isdisplayed on a screen. The potentials are recorded at various locationsof the 3D surface. During playback of the potentials, graphicrepresentations, typically bars having a varying length and/or a varyingcolor that corresponds to a value of the time-varying potentials, arepresented on the map at positions corresponding to the coordinates ofthe locations.

By converting the 3D surface to a two-dimensional map, all locations onthe surface, and associated elements such as the representations ofpotentials described above, may be viewed simultaneously, without anymanipulation of the map. This is in contrast to viewing an unconverted3D surface with associated representations. In this case the 3D natureof the body cavity surface prevents simultaneous viewing of all surfacelocations, and typically requires rotating the surface in order to viewall the locations and their associated representations.

System Description

Reference is now made to FIG. 1, which is a schematic, pictorialillustration of a cardiac electrophysiology (EP) system 20, according toan embodiment of the present invention. In system 20, a probe 22 isinserted into a body cavity 23, such as a chamber of a heart 24, of asubject 26. Typically, the probe is used by a medical practitioner 28during an investigative medical procedure performed on subject 26.

The functioning of system 20 is managed by a system controller (SC) 30,comprising a processing unit 32 communicating with a memory 34, whereinis stored software for operation of system 20. Controller 30 istypically an industry-standard personal computer (PC) comprising ageneral-purpose computer processor. However, in some embodiments, atleast some of the functions of the controller are performed usingcustom-designed hardware and software, such as an application specificintegrated circuit (ASIC) or a field programmable gate array (FPGA).Controller 30 is typically operated by practitioner 28 using a pointingdevice 36 and a graphic user interface (GUI) on a screen 38, the deviceand the GUI enabling the practitioner to set parameters of system 20.Screen 38 typically also displays results, via the GUI, of the procedureto the medical practitioner.

The software in memory 34 may be downloaded to the controller inelectronic form, over a network, for example. Alternatively oradditionally, the software may be provided on non-transitory tangiblemedia, such as optical, magnetic, or electronic storage media.

Probe 22 is configured to measure electrophysiological potentials ofheart tissue over time, using one or more electrodes 42 located on adistal tip 40 of the probe, as illustrated in a magnified section 44 ofFIG. 1. The one or more electrodes may be used for other purposes aswell, such as for tracking a location and/or an orientation of thedistal tip. Electrodes 42 are connected by wires (not shown) in probe todriver and measurement circuitry in system controller 30.

Alternatively or additionally, the location and/or the orientation ofthe distal tip may be ascertained by other systems known in the art, forexample, by a magnetic tracking system. One such magnetic trackingsystem is the CARTO 3 system, produced by Biosense Webster, Inc, DiamondBar, Calif., which tracks the distal tip by using alternating magneticfields to induce corresponding positioning currents in coils in the tip.

During the investigative medical procedure referred to above,practitioner 28 positions probe 22 at a number of locations in heart 24to measure the electrical potentials at the locations. Typically, ateach location the practitioner uses controller 30 to record theelectrical potential as it varies in time, together with the times.Alternatively or additionally, the practitioner positions multipleprobes, substantially similar to probe 22, at some of the differentlocations, so as to be able to measure and record the potentials andtimes at these locations substantially simultaneously.

While the number of locations at which the potential is measured istypically of the order of 100, embodiments of the present invention arenot limited to the number of locations, and so comprise numbers oflocations smaller and larger than 100. For simplicity and clarity, thefollowing description considers the results from six locations, andthose having ordinary skill in the art will be able to adapt thedescription for other numbers of locations.

FIG. 2 is a schematic diagram illustrating two different views ofelements of heart 24, according to an embodiment of the presentinvention. The diagram shows representations of a three-dimensional (3D)interior surface 70 of heart 24. The representations are generated byusing distal tip 40 to establish locations in space of the surface,using one of the tracking systems referred to above. The locations arerecorded by system controller 30, which uses the locations, typicallywith an interpolation procedure, to formulate a 3D map of the surface.

A view 80 shows 3D surface 70 from a first viewpoint, and a view 82shows the surface from a second viewpoint. View 80 is herein alsoreferred to as frontal view 80. View 82, also herein referred to as sideview 82, is related to frontal view 80 by being rotated approximately90° around a vertical axis 84. The direction of rotation iscounter-clockwise looking down along the axis. The rotation moves thepoints of the surface in the two viewpoints, so that some points remainvisible in both viewpoints, but some are only visible in one of theviewpoints.

For example points 86 and 88 are on the left of axis 84 in the frontalview, and rotate to the right of axis 84 in the side view. Points 90 and94 are visible, at the right of axis 84, in the frontal view, but arenot visible in the side view, and points 92 and 96 are not visible inthe frontal view, but become visible, because of the rotation, in theside view.

FIG. 3 is a schematic diagram of a two-dimensional (2D) map 120,according to an embodiment of the present invention. Map 120 is atwo-dimensional projection of 3D surface 70, so that every location onthe 3D surface maps in a one-to-one correspondence to a respective,different point, on 2D map 120. Map 120 is formulated in atwo-dimensional coordinate frame having orthogonal x and y axes, andeach of the points of the map have respective coordinates in the frame.By way of example, points 86, 88, 90, 92, 94, and 96 of surface 70 mapto respective different points 86M, 88M, 90M, 92M, 94M, and 96M on map120. The one-to-one correspondence, or mapping, between the points onthe 3D surface and map 120 may be by any mathematical functiontransforming coordinates of the 3D surface to two-dimensionalcoordinates, or ordered (x, y) pairs, defining 2D map 120.

By way of example, a perimeter 122 of map 120 is shown as beingcircular, but in alternative embodiments of the present invention themap may have any convenient two-dimensional perimeter, including curvedand straight linear sections. An interior region 124 within perimeter122 is assumed, by way of example, to be a single contiguous area,completely filling the perimeter. However, in other embodiments,interior region 124 comprises more than one contiguous area. Each sucharea may or may not contact other such areas within region 124. In allcases, each point in perimeter 122 and region 124 maps in a one-to-onecorrespondence with a respective point of 3D surface 70.

By way of example, map 120 may be considered as a geometrical projectiononto a plane at right angles to an axis between the apex of the heartand the center of the left ventricle. In the illustration the map hasbeen divided into nine regions formed as three concentric sub-regions:an apical central region 121, a middle region 123, and a basal, outerregion 125. Moving from region 121 to perimeter 122 corresponds tomoving from the apex to the base of the left ventricle. This division,as will be apparent to those of ordinary skill in the art, is consistentwith the common artery blood supply, However, any other convenientdivision of map 120 may be used, or the map may not be subdivided.

Map 120 is displayed on screen 38. Typically, annotations 126, such as“anterior” and “posterior,” may be placed on or besides the map, toassist practitioner 28 in associating elements of map 120 withcorresponding elements of 3D surface 70. The annotations are typicallydescriptive of the associated elements. Alternatively or additionally,interior region 124 may comprise map markings 128, such as lines and/orshadings and/or colorations to correspond with features such as scars orboundaries or delineations of surface 70.

FIG. 4 is a schematic diagram of voltage vs. time graphs, according toan embodiment of the present invention. Typically, while data for 3Dsurface 70 of heart 24 is being assembled by operator moving the probeto contact surfaces of the heart, as described above, the probe measurespotentials at the points of contacts. For each point where thepotentials are measured, controller 30 records a set of potentials andcorresponding times, and stores the set in memory 34. Alternatively oradditionally, sets of potentials and times for points on surface 70 maybe recorded and stored in memory 34 independently of the assembly oflocation data for the 3D surface.

In the following description, controller 30 is assumed to recordinvestigative sets of potentials and times for points 86, 88, 90, 92,94, and 96. The recordings may be made sequentially. Alternatively oradditionally, in the case of the use of multiple probes, at least someof the recordings may be made simultaneously. Typically, duringrecording of a given investigative set of potential/time readings,controller records a reference set of potential/time readings usinganother probe. The reference set may be taken by positioning the probein the coronary sinus, or at any other convenient position of the heartgenerating repetitive electrophysiological signals. Alternatively oradditionally, any other cardiac related signals may be used as areference set, such as body surface electrocardiograph signals.

After the controller has recorded the investigative potential/time sets,the records may be gated using the reference set of readings. The gatingtranslates the investigative sets in time, so that each set of recordshas a common time axis, and is converted to a respective gated set ofrecords. The gated investigative sets of records are stored in memory34. Graphs 156, 158, 160, 162, 164, and 166, herein also referred tocollectively as graphs 168, are graphical displays of the gatedinvestigative sets of readings for points 86, 88, 90, 92, 94, and 96respectively. Graphs 168 have a common time axis 170.

Practitioner 28 replays the gated records by traversing along time axis170, so that as each time on the axis is reached, controller 30 recallsrespective potentials for each point of contact that has been stored inmemory 34. In the case of the six points of contact 86, 88, 90, 92, 94,and 96 assumed above at each instant in time the controller recalls sixpotentials. The time traversal may be conveniently illustrated on graphs168 by a moving vertical line 172. The replay of the gated records maybe manual, by the practitioner effectively moving the position of line172 on the time axis. Alternatively, the replay of the gated records maybe implemented by controller 30 moving line 172 automatically on thetime axis, typically repetitively. By way of example, line 172 is shownat four different times T1, T2, T3, and T4.

As explained above, the gated records comprise records of potentials vs.times for selected points of surface 70. In displays 200, 2D map 120 isused as a basis for the replay, and graphic representations or symbols,representative of the recorded potentials for particular points, arecoupled to the respective point on the 2D map. The graphic symbol isselected to be uniquely representative of the potential level.

In a first embodiment, the graphic symbol comprises a rectangular bar,the length of the bar being adjusted according to the level of thepotential. In a second embodiment, the graphic symbol comprises arectangular bar, a color of the bar changing according to the level ofthe potential. A third embodiment represents the potential by arectangular bar wherein both the color and the length of the bar changeaccording to the potential level. Typically, a reference scale, showingthe relation between the graphic symbol and the potential level, isshown on screen 38.

The figure illustrates examples of a fourth embodiment, based on thegraphs of FIG. 4. Respective graphic representations 86G, 88G, 90G, 92G,94G, and 96G at points 86, 88, 90, 92, 94, and 96 display the differentpotentials at these points. Graphic representations 86G, 88G, 90G, 92G,94G, and 96G are referred to collectively as representations 98G.Graphic representations 98G are bars having varying lengths andcorresponding different shadings. The comparison between the potentials,bar lengths, and shadings is shown in a reference scale 202. A firstdiagram 204 corresponds to the potentials registered at time T1, anddiagrams 206, 208, and 210 respectively correspond to the potentials attimes T2, T3, and T4.

By way of example, the bars representing the potentials are displayed asparallel to each other, but not parallel to the x or y axes of map 120.However, the bars may be displayed in any convenient direction.

As is apparent from displays 200, at all times practitioner 28 is ableto see the potentials generated by all points on surface 70, and to seeall the potentials simultaneously. Furthermore, because the graphicrepresentations of the potentials are coupled to the points generatingthe potentials, the practitioner is able to easily associate thepotentials with the points. Thus, a “universal” view of all thepotentials is available to the practitioner, without the practitionerhaving to manipulate map 120.

This is in contrast to the situation illustrated in FIG. 2, where, inorder to view all the points on surface 70, the surface needs to berotated. Similarly, if graphic representations of the potentials at thepoints are coupled to the points, at any instant in time, some of thoserepresentations will of necessity be hidden from view, because theircoupled points are hidden from view.

FIG. 6 is a schematic diagram illustrating an alternative graphicdisplay 300 of the replay of the gated records, according to anembodiment of the present invention. Apart from the differencesdescribed below, display 300 is generally similar to one of displays 200(FIG. 5), and elements indicated by the same reference numerals in bothdisplay 300 and displays 200 are generally similar in construction andin operation. For simplicity, FIG. 6 only shows one diagram,corresponding to diagram 204 of FIG. 5.

Display 300, in addition to presenting the elements of diagram 204,presents further information concerning body cavity 23 that is relevantto the procedure being performed by practitioner 28. The information isincorporated into map 120. The other information illustrated in display300 comprises isochronal potential lines 302 and 304 which are lines onmap 120 indicating regions having, at a given time, equal voltages.Lines 320 and 304 translate to corresponding isochronal potential lineson surface 70. It will be understood that the isochronal linesillustrated in display 300 are examples of relevant information, otherthan that illustrated in diagram 204, which can be incorporated into map120, so that embodiments of the present invention include incorporationof all such information into the map.

While the embodiment above have assumed that map 120 is of the wholeheart, it will be understood that embodiments of the present inventioncomprise displaying a section of the heart, such as a portion containingscar tissue. The section displayed may be selected manually,semi-automatically, or automatically.

In an alternative embodiment, rather than the graphic representationdisplaying all values of the potential at a point, a window ofpotentials can be selected for display. Further alternatively, thegraphic representation may be configured to display one particular valueof potential.

It will be appreciated that the embodiments described above may be usedto delineate and display paths, such as reentry and/or slow pathwaysfollowed by potentials in the heart.

It will thus be appreciated that the embodiments described above arecited by way of example, and that the present invention is not limitedto what has been particularly shown and described hereinabove. Rather,the scope of the present invention includes both combinations andsubcombinations of the various features described hereinabove, as wellas variations and modifications thereof which would occur to personsskilled in the art upon reading the foregoing description and which arenot disclosed in the prior art.

I claim:
 1. A method, comprising: generating a plurality ofthree-dimensional representations of a surface of a body cavity bycontacting a distal tip of a probe having an electrode on the surface ofthe body cavity and determining locations on the three-dimensionalrepresentations of the surface using the electrode, each representationbeing a different view of the same surface of the body cavity from adifferent viewpoint; measuring and recording respective time-varyingelectrical potentials at the locations on the three-dimensionalrepresentations of the surface of the body cavity in each of thedifferent representations using the electrode; formulating a one-to-onecorrespondence between the locations on each of the different views ofthe three-dimensional representations of the surface of the body cavityand coordinates in a single two-dimensional coordinate framerepresentative of the locations; displaying a map of the onetwo-dimensional coordinate frame; and presenting respective graphicrepresentations of the time-varying electrical potentials at positionsin the map corresponding to the coordinates of the locations.
 2. Themethod according to claim 1, wherein the map comprises markingscorresponding to features of the three-dimensional representations ofthe surface.
 3. The method according to claim 1, wherein the mapcomprises annotations descriptive of elements of the three-dimensionalrepresentations of the surface.
 4. The method according to claim 1,wherein the graphic representations comprise rectangular bars havinglengths selected in response the electrical potentials.
 5. The methodaccording to claim 1, wherein the graphic representations comprise barshaving colors selected in response the electrical potentials.
 6. Themethod according to claim 1, and comprising presenting informationconcerning the body cavity, other than the graphic representations, onthe map.
 7. The method according to claim 1, wherein displaying the mapcomprises selecting a section of the body cavity, and presenting thegraphic representations only for the section.
 8. The method according toclaim 7, wherein the selecting comprises choosing from a groupcomprising manual selection, semi-automatic selection, and automaticselection.
 9. The method according to claim 1, wherein presenting therespective graphic representations of the time-varying electricalpotentials comprises selecting a window of the potentials, andpresenting the representations in response to the window.
 10. The methodaccording to claim 9, and comprising selecting a section of the bodycavity, and presenting the graphic representations of the window onlyfor the section.
 11. The method according to claim 1, and comprisingdelineating a path followed by the time-varying electrical potentials inthe body cavity, and displaying the path on the map.
 12. The methodaccording to claim 11, and comprising presenting the graphicrepresentations of the potentials only for the path.
 13. Apparatus,comprising: a controller, configured to: generate a plurality ofthree-dimensional representations of a surface of a body cavity from adistal tip of a probe having an electrode in contact with the surface ofthe body cavity and determine locations on the three-dimensionalrepresentations of the surface in response to recordings from theelectrode, each representation being a different view of the samesurface of the body cavity from a different viewpoint; measure andrecord respective time-varying electrical potentials at the locations onthe three-dimensional representations of the surface of the body cavityin each of the different representations using the electrode; formulatea one-to-one correspondence between the locations on each of thedifferent views of the three-dimensional representations of the surfaceof the body cavity and coordinates in a single two-dimensionalcoordinate frame representative of the locations; display a map of thesingle two-dimensional coordinate frame on a display screen; and presentrespective graphic representations of the time-varying electricalpotentials at positions in the map corresponding to the coordinates ofthe locations.
 14. The apparatus according to claim 13, wherein the mapcomprises markings corresponding to features of the three-dimensionalrepresentations of the surface.
 15. The apparatus according to claim 13,wherein the map comprises annotations descriptive of elements of thethree-dimensional representations of the surface.
 16. The apparatusaccording to claim 13, wherein the graphic representations compriserectangular bars having lengths selected in response the electricalpotentials.
 17. The apparatus according to claim 13, wherein the graphicrepresentations comprise bars having colors selected in response theelectrical potentials.
 18. The apparatus according to claim 13, whereinthe screen is configured to present information concerning the bodycavity, other than the graphic representations, on the map.
 19. Acomputer software product comprising a non-transitory computer-readablemedium having computer program instructions recorded therein, whichinstructions, when read by a computer, cause the computer to: generate aplurality of three-dimensional representations of a surface of a bodycavity from a distal tip of a probe having an electrode in contact withthe surface of the body cavity and determine locations on thethree-dimensional representations of the surface in response torecordings from the electrode, each representation being a differentview of the same surface of the body cavity from a different viewpoint;measure and record respective time-varying electrical potentials atlocations on the three-dimensional representations of the surface of thebody cavity in each of the different representations using theelectrode; formulate a one-to-one correspondence between the locationson each of the different views of the three-dimensional representationsof the surface of the body cavity and coordinates in a singletwo-dimensional coordinate frame representative of the locations;display a map of the single two-dimensional coordinate frame; andpresent respective graphic representations of the time-varyingelectrical potentials at positions in the map corresponding to thecoordinates of the locations.